Why Antidepressants Do Live Up to the Hype: I See a Cup Half Full

I always get a little irritated with articles like the one just published in Time magazine: "Why Antidepressants Don't Live Up to the Hype" by John Cloud.

Why?

Because I know that somewhere out there is a person who is desperately in need of treatment for severe depression, but an article like that could be the deciding factor not to pursue it.

I know that because I've been there.

Three years ago a friend who was opposed to my taking medication handed me a copy of O Magazine's article, "The Valley of the Dulls: On Taking Antidepressants," which featured interview after interview with folks who claimed that antidepressants zapped their creativity, personality, cognitive functions, and range of emotions.

I was on my way to a psychiatric consultation at Johns Hopkins. Already having tried six psychiatrists, Hopkins would be the final push before giving up. And that article almost made me turn the car around. And to think, I would have been so close to finally getting the treatment I needed.

So hear me out. I need to fill in the holes on Cloud's story.

Cloud writes, "a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor, and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression." Yes, but .... You need to understand this in the context that J. Raymond DePaulo, Jr., a psychiatrist at Johns Hopkins School of Medicine presents in the summer 2008 issue of the "Johns Hopkins Depression and Anxiety Bulletin":

What the PLoS study found is that, on average, patients taking medication had a substantial response as measured by a depression rating scale. Whereas they started with a score of roughly 26 (on a 54-point scale, where higher means more depressed), they dropped after six weeks of treatment to about 16.

But the patients taking placebos also, on average, had a strong response, dropping to about 18.

However, the placebo picture was a bit more complicated. Unlike the antidepressants response, which did not vary based on how initially depressed patients were, the placebo response was strongest in the LEASED-DEPRESSED folks, dropping off in those who illness was more severe.

So here's take-home message No. 1: Antidepressants showed a significant advantage over placebo for the severely depressed patients but not for the mildly and moderately depressed patients.

Maybe that's not really so surprising.

Then Cloud discusses the government-funded trial called the Sequence Treatment Alternatives to Relieve Depression (STAR*D). It analyzed 2,876 people across the country suffering from major depressive disorder, and is the first study to provide scientific data on what to do for those patients who are treatment-resistant.

Cloud writes:

Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients - those with a limited range of psychological problems. People whose depressed is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs - which is unfortunate for the 45 to 60 percent of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse.

Now, had I not had some literature from Johns Hopkins about the same study, I might have read that, as a person who struggles with depression, and say, "Man, it's never going to get better. Maybe I should just check out right now."

I'm not going to say that, though, because I know better. And because I have read a different interpretation of the same study in the Spring 2009 Issue of the Johns Hopkins Depression and Anxiety Bulletin:

STAR*D is a landmark study: For the first time, doctors and people suffering from depression have extensive data from the large-scale, long-term study directly comparing antidepressant treatment strategies.

If you are on an antidepressant to treat depression and are not feeling any better, the STAR*D results are particularly relevant to you.

Don't give up on medication! That is the most important message to understand. You may need a higher dose, a longer duration of therapy, a different drug altogether, or a combination of medications. Experimenting with these treatment options can lead to recovery for almost 70 percent of severely depressed people.

Again: Experimenting with treatment options can lead to recovery for almost 70 percent of severely depressed people.

That's hardly disappointing to me. It's much more than half. And with all the other tools of my recovery--therapy, cognitive behavioral therapy, prayer and meditation, fish oil, reaching out, calling on friends, exercise, and writing--I can take my chances for recovery much higher than 70 percent.

So, I'd say, what we have here, in STAR*D, is a glass half full. To my eyes, anyway.